Thursday, June 02, 2005

Well, actually, he is. And to his credit, he wants to do something about it: he wants to undergo weight-loss surgery in order to treat his morbid obesity. Which is commendable, if drastic.

And he wants his insurance to pay for it.

Which is unrealistic.

By and large, carriers do not cover weight-loss surgery. Or stop-smoking programs, infertility treatments, or growth-hormone regimens.

There’s actually a very good reason for this: they are not issues which should be covered by medical insurance. Look at it this way: do we expect our auto insurance to cover oil-changes or transmission repairs? Do we rely on our homeowners insurance to pay for leaky roofs (I’m talking about ordinary wear-and-tear, not hail or tornadoes) or cleaning out our chimneys?

Insurance is expensive enough without adding even more overhead to plans.

Is it discrimination against obese folks?

Yes, but discrimination is not, in and of itself, a bad thing. We all discriminate: Wendy’s over McDonald’s, steak over chicken, Honda over Kia, the list goes on. Carriers discriminate against smokers and diabetics, males and females, teenagers and seasoned citizens. Risk-management means that certain classes of folks are higher risks than others, and certain medications, treatments and procedures won’t be covered, because covering them would make plans so expensive that NO ONE would buy them.

My erstwhile client directed me to ObesityLaw.com, which is “the first and premier advocacy practice devoted to representing the interests of morbidly obese persons in health care and discrimination matters.” While the site is heavy on the “sue the bastards” rhetoric, it does offer some ideas about different procedures and resources, as well. And there is apparently a pretty large grass-roots effort toward legislation to prohibit discrimination against the obese.

Nationally, there are currently 25 different bills in congress that deal with obesity issues. So it’s not easily dismissed.

My friend Bob Vineyard has pointed me to an article which really explains what bariatric surgery is - and isn't - and some of the other issues surrounding this controversial procedure. It doesn't settle the debate, but it certainly sheds additional light on the subject.

I tend to be somewhat of a purist when it comes to insurance: it’s about managing risk, and that means defining what should and shouldn’t be covered from an economic, rather than a social, viewpoint. Now, before the flaming begins: I am aware that it seems oxymoronic that an insurer won’t pay for bariatric surgery, but it will cover the resulting heart-attack and quadruple bypass.

I never said that insurance had to make sense.

But think about it: there’s no way to exclude a heart attack that’s specifically caused by morbid obesity. This is a systemic issue, and there’s no way to appropriately (and legally) word such an exclusion. Not to mention, there’s little chance that said heart attack was caused solely by the obesity; there are almost always other factors, as well.

Just food for thought.

UPDATE: Once again, a big InsureBlog Welcome to our Grand Rounds visitors. Please feel free to leave a comment, and to look around at some of the other posts here.

Well, actually, he is. And to his credit, he wants to do something about it: he wants to undergo weight-loss surgery in order to treat his morbid obesity. Which is commendable, if drastic.

And he wants his insurance to pay for it.

Which is unrealistic.

By and large, carriers do not cover weight-loss surgery. Or stop-smoking programs, infertility treatments, or growth-hormone regimens.

There’s actually a very good reason for this: they are not issues which should be covered by medical insurance. Look at it this way: do we expect our auto insurance to cover oil-changes or transmission repairs? Do we rely on our homeowners insurance to pay for leaky roofs (I’m talking about ordinary wear-and-tear, not hail or tornadoes) or cleaning out our chimneys?

Insurance is expensive enough without adding even more overhead to plans.

Is it discrimination against obese folks?

Yes, but discrimination is not, in and of itself, a bad thing. We all discriminate: Wendy’s over McDonald’s, steak over chicken, Honda over Kia, the list goes on. Carriers discriminate against smokers and diabetics, males and females, teenagers and seasoned citizens. Risk-management means that certain classes of folks are higher risks than others, and certain medications, treatments and procedures won’t be covered, because covering them would make plans so expensive that NO ONE would buy them.

My erstwhile client directed me to ObesityLaw.com, which is “the first and premier advocacy practice devoted to representing the interests of morbidly obese persons in health care and discrimination matters.” While the site is heavy on the “sue the bastards” rhetoric, it does offer some ideas about different procedures and resources, as well. And there is apparently a pretty large grass-roots effort toward legislation to prohibit discrimination against the obese.

Nationally, there are currently 25 different bills in congress that deal with obesity issues. So it’s not easily dismissed.

My friend Bob Vineyard has pointed me to an article which really explains what bariatric surgery is - and isn't - and some of the other issues surrounding this controversial procedure. It doesn't settle the debate, but it certainly sheds additional light on the subject.

I tend to be somewhat of a purist when it comes to insurance: it’s about managing risk, and that means defining what should and shouldn’t be covered from an economic, rather than a social, viewpoint. Now, before the flaming begins: I am aware that it seems oxymoronic that an insurer won’t pay for bariatric surgery, but it will cover the resulting heart-attack and quadruple bypass.

I never said that insurance had to make sense.

But think about it: there’s no way to exclude a heart attack that’s specifically caused by morbid obesity. This is a systemic issue, and there’s no way to appropriately (and legally) word such an exclusion. Not to mention, there’s little chance that said heart attack was caused solely by the obesity; there are almost always other factors, as well.

Just food for thought.

UPDATE: Once again, a big InsureBlog Welcome to our Grand Rounds visitors. Please feel free to leave a comment, and to look around at some of the other posts here.